HomeMy WebLinkAboutBLDCI-17-002993-03 m.
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The Commonwealth of Massachusetts
'i_r=_ a City\Town of
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YARMOUTH YARMOUTH
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New and Renewal Certificate of Inspection
In accordance with 780 CMR,Chapter 1 (The Eighth Edition of the Massachusetts State Building Code)and Chapter 304 of the Acts of 2004(an Act to further
enhance fire and life safety),this certificate of inspection is issued to the premise or structure or part thereof as herein identified.
Identify Name of Establishment Certificate No.
Issued to
Business Name:JOCA LLC BLDCI-17-002993-03
Trade Name:YARMOUTH PIZZA BY EVAN
Identify property address including street number,name,city or town and county Certificate Expiration
Located at
559 ROUTE 6A 12/31/2019
YARMOUTH,MA 02675
Use Group Floor Occupancy Use Group Other
Classifications(s)
A-2 01st Floor 31 A-2 Nightclub/Restaurant/Bar/Banquet Hall 28 Persons-Tables 8
Chairs
Allowable 6 Persons-Stools
Occupant Load 31 Seals-TOTAL
OCCUPANCY PER BOH
This certificate of inspection is hereby issued by the undersigned to certify that the premise,structure or portion thereof as herein specified has been inspected for
general fire and life safety features. This certificate shall be framed behind glass and/or laminated and posted in a conspicuous place within the space as directed
by the undersigned. Failure to pose or tampering with the contents of the certificate is strictly prohibited
Name of Municipal Philip Simonian III Name of Municipal Mark Grylls Date of //�
Fire Chief Building Commissioner Inspection
Signature of Municipal Air / / Signature of Municipal ' Date of
Fire Chief /f / / ' rte Building Commissioner /, Issuance
Aseli-
ee 4 Fee:$100.00
BLD_Certof nspection.rpt
st,47:a
TOWN OF YARMOUTH
BUILDING DEPARTMENT
1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260
APPLICATION FOR CERTIFICATE OF INSPECTION
October 3,2018 PAYABLE UPON RECEIPT
(X) Fee Required $100.00
( ) No Fee Required
In accordance with the provisions of the Massachusetts State Building Code, Section 110.7, I hereby apply for a
Certificate of Inspection for the below-named premises located at the following address:
Street and Number: `j 5:9 R T G A
Name of Premises: jmeniourii ZZA 1 y EIJ4AI/ Tel: 508 - 3 _ 7t7
Purpose for which permit is used: Pao D seIet/6G�
License(s)or Permit(s)required for the premises by other governmental agencies: ►a E C E I
VED
License or Permit Agency / �J '-'
r7703-1
CT 1018
4t. H ,rc�
AC.COHvt-10t �/gQCPIS jy �RTMENT
Certificate to be issued to C @e f✓i 2ZA 137 G04,t/ Tel: So 93-3 6a
Address: 554 ('fir 4 A
Owner of Record of Building &SM Q'r R 5'4QftbLira Ao4r L.LC
Address SS' RI-6 A
Present Holder of Certificate .70 CA 1-L.C. 061,A PIZZA Q Y taM)
lAb_ Li 6 l_ 44fr2Signatureo .m Title
Certificate is issued o h'. agent /o`/1)/9
Date
Email Address: I trq An) F C0114 G4 Cr . —s-T-'
Instructions: Make check payable to: Town of Yarmouth
1146 Route 28, South Yarmouth,MA 02664
Return this application to: Building Inspector's Office
Please note: Application form with accompanying fee must be submitted for each building or structure or part thereof
to be'certified. Application must be received before the certificate will be issued. The building official shall be
notified within ten(10)days of any change in the above information.
PLEASE SEND US A COPY OF YOUR WORKER'S COMPENSATION INSURANCE FORM WITH THIS
APPLICATION OR WE CANNOT ISSUE YOUR CERTIFICATE OF INSPECTION.
Certificate of Inspection# BL71M.7 - T-L1 en93-0 3
1/1/2019-12/31/2019
bd
NOTICE ) 1 NOTICE
TO
TO
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EMPLOYEES mmw=1 t=
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ODM = s'
The Commonwealth of Massachusetts
DEPARTMENT OF INDUSTRIAL ACCIDENTS
I Congress Street, Suite 100, Boston, Massachusetts 02114 — 2017
617-727-4900 — http://www.state.ma.us/dia
As required by Massachusetts General Law,Chapter 152,Sections 21, 22&30,this will give you notice that
I (we) have provided for payment to our injured employees under the above mentioned chapter by
insuring with:
THE TRAVELERS INSURANCE COMPANIES
NAME OF INSURANCE COMPANY
P.O. BOX 1450
MIDDLEBORO. MA 02344-1450
ADDRESS OF INSURANCE COMPANY
(6HUB-7H82900-6117) 12-30-17 TO 12-30-18
POLICY NUMBER EFFECTIVE DATES
▪ DOWLING & ONEIL INS AGC 973 IYANNOUGH RD
HYANNIS MA 02601
NAME OF INSURANCE AGENT ADDRESS PHONE#
o= JOCA.LLC DBA PIZZAS BY EVAN 559 ROUTE 6A
o= YARMOUTHPORT
MA 02675
• EMPLOYER ADDRESS
o=
EMPLOYER'S WORKERS COMPENSATION OFFICER(IF ANY) DATE
MEDICAL TREATMENT
^- The above named insurer is required in cases of personal injuries arising out of and in the course of
• employment to furnish adequate and reasonable hospital and medical services in accordance with the
• provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the
injured employee. The employee may select his or her own physician. The reasonable cost of the services
provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably
▪ connected to the work related injury. In cases requiring hospital attention, employees are hereby notified
that the insurer has arranged for such attention at the
NAME OF HOSPITAL ADDRESS
000932 W2OP1G1S TO BE POSTED BY EMPLOYER
h
/..: OF.,.--Y BUILDING
; � °9� TOWN O F YARMOUTH ELECTRICAL
~ � �; _
Z t 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451 GAS
i•li Telephone(508)398-2231,Ext.1261 —Fax (508)398-0836 PLUMBING
SIGNS
BUILDING DEPARTMENT
Inspection and License Report //-67-e
Address S9 Re). re Business Name ZZr1 77.ezn7
Conran Phone
During the Annual Inspection of your premises,performed in accordance with the provisions of Section 110.7 of 780 CMR(Massachusetts
State Building Code),the Board of Selectmen,and/or the Board of Health rules,the following violation(s)were observed:
geretc ) L . .
❑ Emergency egress signage Location 44#11 �/ U lm/''"�'i '✓ lilt 7 Q'll
Q Emergency egress lighting Location
❑Maintenance of exits Location
Q Guards/handrails Location
" ,Zoning
Q Signs Location
Q Parking Location
Q Other Location
Mechanical
❑CombusdonAir Location
I]Storagein Boiler Room Location.
❑Vents Location
Q Automatic door closures •
on boiler room doors Location
Q Clothes dryer vents Location
9th¢ Location
The State Building Code,Section 1001.3-,Maintenance,provides that the owner as defined in Section 780 CMR shall be
responsible for proper maintenance.
In order to abate the above violation(s)you must
o Make corrections Immediately and contact this office for a follow-up inspection.
o Make corrections prior to opening and contact this office for a follow-up inspection.
o Make corrections prior to your next annual inspection.
o Make corrections within, 7/ i days andcontactthis office for a follow-up Inspection.
Loa3XlOfficial/Inspector 4O 1y C/
Received By C Tide
Revised 2/8/13